Understand Cortisol And Its Impact On Blood Glucose
We all live stressful lives, but some of us have a harder time reducing or releasing our stress. That fact may play out in restlessness, poor sleep, insomnia, or feelings of anxiety or constant tension. Cortisol is the stress hormone that mediates the fight or flight physiologic response. And it has a direct bearing on our glucose levels.
Prolonged cortisol stimulation will raise blood glucose levels, notes Dr. Jason Fung, who wrote an entire chapter on the stress hormone in his 2016 bestseller The Obesity Code.8 In it he describes how cortisol, released from the adrenal glands, sends a message to the body to release glucose to prepare for a perceived threat, spurring gluconeogenesis in the liver. In prehistoric times, that surge of glucose energy was usually used up fighting or fleeing from the threat. But in current days, often that stress goes unreleased, the energy not used, which can lead to prolonged higher glucose levels
I, too, discovered the same stress impact, especially with sleep. Since this spring, I am doing yoga in the early evening, focusing on other stress reduction activities and wearing earplugs and an eye shade to help ensure a better night sleep. Doing so drops my FBG back into the normal range the next morning.
Drinking a glass or two of wine at night can lower readings, too, because the liver metabolizes the alcohol first before turning to gluconeogenesis, but I dont want to drink daily.
How Can I Lower My Blood Glucose
If you’ve been diagnosed with diabetes, follow your doctor’s instructions for taking medicines and monitoring and managing your blood sugar.
If you have prediabetes, here’s what you can do to reduce your risk for developing diabetes:
- Lose weight if you’re overweight. “Diabetes is increasingly more common, and the largest driving force is the excess body weight people carry these days,” says Dr. Eckel.
- Be physically active. You may be able to prevent or delay type 2 diabetes by exercising 150 minutes a week and losing about 7 percent of your body weight, according to the Mayo Clinic.
- Eat a healthy diet. That means fewer sugary or processed foods and more vegetables, fruits, whole grains and lean proteins.
What Causes High Blood Sugar Levels
Managing diabetes is like a three-way balancing act because you have to watch:
All three need to be balanced. If any one of these is off, blood sugar levels can be too. In general, higher than normal blood glucose levels can be caused by:
- not taking your diabetes medicine when you’re supposed to or not taking the right amounts
- not following the meal plan
- not getting enough exercise
- having an illness, like the flu
- taking other kinds of medicines that affect how your diabetes medicines work
A single high blood sugar reading usually isn’t cause for alarm it happens to everyone with diabetes from time to time. But if you have high blood sugar levels a lot, let your parents and your diabetes health care team know. Insulin or meal plans may need adjusting, or you may have an equipment issue, like an insulin pump that isn’t working right. Whatever the case, make sure you get help so you can get your blood sugar levels back under control.
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What Is High Blood Glucose
To fully understand your blood glucose levels, itâs important to know: a) what values are actually considered high, and b) factors that can cause your elevated reading in the first place.
High blood glucose, also known as hyperglycemia, occurs when there is too much sugar in the bloodstream. Low blood sugar, or hypoglycemia, is the result of too little glucose in the bloodstream. Hyperglycemia usually occurs because your body doesnât produce enough insulin or canât properly use the available insulin to remove the glucose from the bloodstream.
Using milligrams of glucose per deciliter of blood for measurement, high blood glucose readings after a meal indicating prediabetes can fall between 140 and 199 mg/dL. Levels reaching 200 mg/dL two hours after eating indicate you may already be insulin resistant or diabetic, though that diagnosis will need to come from your doctor. By comparison, the typical standard for normal glucose readings is to remain under 140 mg/dL throughout the day and under 100 mg/dL after eight hours of fasting.
A range of lifestyle factors, habits, and health conditions can cause high blood sugar. To debunk common hyperglycemia myths, review causes and symptoms, and discuss the best ways to address them, we spoke with two experts on high blood sugar levels: registered dietitian and For The Love of Diabetes creator Lori Zanini and registered dietitian nutritionist and diabetes management expert .
Planning For Sick Days
Your body releases stress hormones when you are sick, which can cause hyperglycemia. Keep taking your insulin and other diabetes medications, even if you are throwing up. If you have ketones and your blood sugar is above 240 mg/dL, call your doctor. They might also want you to call if:
- You have diarrhea that lasts more than 6 hours
- You are throwing up
- You have a high fever or trouble breathing
- You feel very sleepy or confused
Continue checking your blood sugar levels and keep track of the results.
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Why Do These Symptoms Matter For Diabetics
These symptoms are essential for diabetics to understand, because they may encounter high or low blood sugar levels from time to time.
A cold or virus can cause sudden high blood sugar levels, and understand the symptoms means knowing how to deal with hyperglycemia or hypoglycemia.
People with diabetes who can recognise the symptoms can avoid levels that lead to medical emergencies such as diabetic ketoacidosis
Why They Happen And How To Try And Reduce Them If You Live With Type 1 Diabetes
Living with type 1 diabetes requires you to regularly check your blood sugar levels before you eat. However, we may not always consider what happens to our sugar levels immediately after we eat where it is very normal for people who dont have diabetes, let alone those who do, to temporarily have high sugar levels. Given that having high sugar levels can give you symptoms like thirst, tiredness and needing to go to the toilet a lot, learning about ways to try and reduce spikes in your sugar levels after meals may make a difference to your overall health and wellbeing.
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What Are The Risks Of Hyperglycemia
Hyperglycemia can be a sign that your body isnt getting enough insulin. It is normal for patients with T1D to get hyperglycemia, and most of the time this is simply treated with insulin. If the body does not have insulin for approximately 8 hours, you could develop a condition called diabetic ketoacidosis, or DKA.
In DKA, your body breaks down fat for energy because it doesnt have enough insulin to use the sugar in your blood. This produces chemicals called ketones, which make your blood more acidic.
DKA is dangerous. Too much acid in your blood can make you pass out or even cause death.
What Causes High Morning Blood Sugars
Two main culprits prompt morning highs: the dawn phenomenon and waning insulin. A third, much rarer cause, known as the Somogyi effect, may also be to blame.
The occasional morning high will have little impact on your A1C, a measure of your average blood sugar levels over time that indicates how well managed your diabetes is. But if those highs become consistent, they could push your A1C up into dangerous territory.
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What You Can Do
If the dawn phenomenon affects you, try to:
- Eat dinner earlier in the evening.
- Do something active after dinner, like going for a walk.
- Check with your health care provider about the medicine youâre taking.
- Eat breakfast. It helps bring your blood sugar back to normal, which tells your body that it’s time to rein in the anti-insulin hormones.
- Eat a snack with some carbohydrates and protein before bed.
You’ll also want to avoid all sugar-sweetened beverages, like soda, fruit punch, fruit drinks, and sweet tea. Just a single serving can raise your blood sugar — and, in some cases, give you hundreds of extra calories.
If you have diabetes, chances are your blood sugar will be higher in the morning from time to time. That may not be something to be overly concerned about. If it happens for several mornings in a row, check it once during the night — around 2 or 3 a.m. — for a few nights. Then, take those numbers to your doctor. They can figure out if you really have the dawn phenomenon, or if something else is causing those higher morning numbers.
Diabetes Stops Here: “Why All the Morning Highs?”
Mayo Clinic: “What is the dawn phenomenon that some people with diabetes experience? Can anything be done about it?”
American Diabetes Association: “Diabetes Myths.”
Diabetes Forecast: “Why Is My Blood Glucose So High in the Morning?”
What If It Goes Untreated
Hyperglycemia can be a serious problem if you don’t treat it, so it’s important to treat as soon as you detect it. If you fail to treat hyperglycemia, a condition called ketoacidosis could occur. Ketoacidosis develops when your body doesn’t have enough insulin. Without insulin, your body can’t use glucose for fuel, so your body breaks down fats to use for energy.
When your body breaks down fats, waste products called ketones are produced. Your body cannot tolerate large amounts of ketones and will try to get rid of them through the urine. Unfortunately, the body cannot release all the ketones and they build up in your blood, which can lead to ketoacidosis.
Ketoacidosis is life-threatening and needs immediate treatment. Symptoms include:
- Shortness of breath
Talk to your doctor about how to handle this condition.
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How Do I Detect Spikes In My Sugar Levels
The exact timing of blood sugar spikes can vary from person to person and meal to meal. However, on average, the post-meal peaks tend to be about one hour and 15 minutes after starting a meal.
The best way to measure post-meal patterns is by using a continuous glucose monitor or Flash monitors. These devices can give you a clear view, including graphs, of what happens with the glucose levels after meals without the need for finger pricking . You can ask your diabetes health team if they are available for you as they are not available to everybody.
If you are not using a CGM, then please speak to your healthcare team about the best way to do this for you with finger prick testing.
How do I know it is a spike?
There is no universal answer or specific guidelines on when a sugar level is too high after meals. However, if post-meal readings are consistently above your target range , then you should discuss whether it would be beneficial for you to address these spikes and how to do this, with your healthcare team .
If you are reviewing your post-breakfast sugar levels, you should also be aware of changes in your hormones in the morning, which cause increases in sugar levels . This Digibete video may help.
Some ways to reduce blood sugar spikes after meals
1. Choose low glycaemic index foods
When blood sugar levels are low or hypoglycaemic we need high glycaemic index foods , such as dextrose tablets or juice, that are absorbed quickly to raise our levels and to treat the hypo.
Being Extra Thirsty And Having To Urinate More Than Usual
This is a common but not-so-obvious sign of blood sugar that is too high: feeling really thirsty and needing to drink more than usual. Excessive urination, known as polyuria, occurs when glucose builds up in your blood, and your kidneys begin working harder to get rid of the extra glucose, says Zanini. If your kidneys cant keep up and adjust blood sugar so that it returns to a normal level, the excess sugar is flushed out of your body through urine, she adds. You may become dehydrated and get dizzy.
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How Do I Treat Hyperglycemia
You can often lower your blood glucose level by exercising. However, if your blood glucose is above 240 mg/dl, check your urine for ketones. If you have ketones, do not exercise.
Exercising when ketones are present may make your blood glucose level go even higher. You’ll need to work with your doctor to find the safest way for you to lower your blood glucose level.
Cutting down on the amount of food you eat might also help. Work with your dietitian to make changes in your meal plan. If exercise and changes in your diet don’t work, your doctor may change the amount of your medication or insulin or possibly the timing of when you take it.
I Feel Fine So I Dont Need To Test My Levels
Zanini points out that having high blood glucose can come as a surprise to anyone. âIt’s possible they didn’t notice any symptoms or were simply feeling ‘more tired than usual,ââ she says. âIt’s easy to attribute being tired to many other things. . .so this is why regular physicals with your healthcare provider are important.â The bottom line? Listen to your body, take note of symptoms as they arise, and consider monitoring your continuous glucose values.
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For People With Type 1 Diabetes
Contact your doctor or go to hospital if:
- Vomiting stops you from drinking and makes eating difficult
- Blood glucose levels remain high
- Moderate to large ketones are present in the urine.
In type 1 diabetes, high blood glucose levels can progress to a serious condition called Ketoacidosis.
What Causes High Blood Sugar Levels In The Morning
Commonly known reasons why your blood sugar may be high in the morning include high-carb bedtime snacks and not enough diabetes medications.
Yet two lesser-known reasons may be causing your morning blood sugar woes: the dawn phenomenon and the Somogyi effect. These causes of high morning blood sugar levels are a result of body changes and reactions that happen while you are sleeping.
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When To See A Healthcare Professional
Hyperglycemia can happen suddenly after injury or illness. If you are experiencing any of the following symptoms call 911 or have someone else call for you:
- Trouble breathing or talking
- Weakness or confusion
The aforementioned signs and symptoms can be a signal of diabetic ketoacidosis or worse, and if left untreated can be life-threatening. Fortunately, immediate recognition and treatment of these symptoms can lead to a rapid amelioration of your high blood sugar levels.
Although more research needs to be done to elucidate the long-term impacts of hyperglycemia on nondiabetic patientsespecially after acute injuryone thing is clear: living a healthy lifestyle that includes eating a balanced diet and routine exercise is the best way to avoid hyperglycemia and acute complications.
To prevent hyperglycemia:
A Word About Lada Latent Autoimmune Diabetes In Adults
If all of the information in this post does not help you understand your rising blood glucose on the low-carb diet, and your blood glucose continues to rise higher and higher, not only in the morning but at other times of day, there may be a potential issue of latent autoimmune diabetes in adults , also sometimes called type 1.5 diabetes.11
Both Dr. Hallberg and Dr. Fung say they see LADA regularly among their patients who may have been misdiagnosed with type 2 diabetes and have LADA instead.
LADA is like type 1 diabetes in that antibodies are attacking the insulin-producing cells of the pancreas, but it arises in adulthood, not in childhood or adolescence. Diabetes researchers note that LADA also has features of type 2 diabetes, but the patients usually are thinner and progress to needing insulin faster because their insulin-producing beta cells have been attacked by antibodies. The highest rates of LADA are found in Northern Europe, with up to 14% of those with type 2 diabetes actually having it.12
I test serum C-peptide and insulin in everybody in my Intensive Dietary Management program, notes Dr. Fung. I re-check them over time and it often takes 6 months to 1 year to clinch the diagnosis. I would suspect about 5-10% of my type 2s are actually LADA.
Dr. Naiman has similar experiences and routines.13
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How To Stabilize Your Blood Sugar Overnight
The most important thing you can do to stabilize your blood sugar is monitor your glucose levels at bedtime, during the night, and when you wake up to look for patterns. This will help you determine whats going on in your body and how you can fix it. While there are many strategies people use to stabilize blood sugar at night, every person is different youll have to look for trends in your body, experiment with ways to lower glucose levels over a period of time, and learn what works best for your body.
Check your blood sugar before bed. If its already high, your blood sugar levels may remain high throughout the night. To address this, youll want to start by adjusting when you eat your evening meal and what it consists of, and how much mealtime insulin you take to cover it.
Avoid eating lots of food close to bedtime. For diaTribe writer Adam Brown, the key to staying in range overnight is low-carb, early dinners, with no snacking after dinner.
Consider eating less food at night and taking more basal insulin to cover your evening meal.
Check your blood sugar during the night, between midnight and 3am. If you were in range before bed but have high glucose levels between midnight and 3am, you may need to adjust your basal insulin dosage and timing. If you are low during that time, you may experience a rebound high blood sugar later on this is usually associated with overcorrecting the low.